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Knowledge is Power: Always Read Your Health Insurance Policy Document

Karen Menezes Karen Menezes 28 September 2016

Why is it so important to read your health policy document before buying a policy? Read ahead to know what you should pay attention to while seeing your policy document.

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The rising cost of healthcare makes it necessary for every individual to buy a health insurance policy. It provides better and timely access to medical care, especially during an emergency. But buying a policy is not enough. Ask your insurance agent to give you its details. You must find out what type of plan suits your requirements before buying one. Once you have the policy document, make sure that you read it immediately and understand everything it says.

Know the Network Hospitals

After buying the policy, go through the booklet containing the list of hospitals. Mark the ones near your home and office. Find out whether your regular physician or hospital is also listed. The network will not include all hospitals. You can make a cashless claim only at the listed hospitals. If you rush to an unlisted hospital in an emergency, you may have to pay and get your claim reimbursed, or even worse, have your claim rejected.

What are Your Benefits?

The ‘Benefits’ section in the policy document lists the services the insurer covers. For example, will the policy cover the cost of bed? Will it cover the pre-hospitalisation medical expenses? Will it pay for treatment done at home? The section mentions all the possible benefits to which the insured is entitled. Also, remember to read the ‘Exclusions’ and ‘Limitations’ sections. Your insurance will not cover items listed in this section—for example, cosmetic surgery or mental disorders.

How Should You Make A Claim?

Medical emergencies can occur at any time. It is best to be aware of the procedures for filing a claim and notify the insurer. The general conditions in your policy mention how and when you should notify your insurer to avail of the benefits in case of an emergency or a planned hospitalization. You will also find the procedure for cashless or reimbursement services and the documents required. Remember important dates

The policy date and the effective date may vary. The effective date is the day of which the health insurance covers you. Keep the expiry date in mind, because that is when your policy will be due for renewal. Skipping renewal on this date will cancel the renewal benefits you are entitled to. You may get a certain grace period for renewal, but this varies from insurer to insurer.

Be Aware of The Waiting Period

You can learn about the waiting period for your policy under the exclusions clause. The insurer does not cover any treatment you get during this period. This period begins from the effective date of your policy and can range from 30 days to 48 months. Some illnesses or treatments have specific waiting periods, after which those are included.

Pay Attention to Riders

The changes or add-ons requested in policy, which alter the standard terms and conditions, are riders or endorsements. You can get coverage for an individual treatment that the policy excludes, by paying some additional premium. An example could be cataract surgery. These are mentioned in the Annexure to the policy. Read it well to know whether all the riders have been covered.

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Karen Menezes
Written by Karen Menezes
An optimist at heart, Karen loves to see the world through a pair of rose-tinted glasses. An award-winning blogger, she loves to dream with her eyes open. Writing is not her passion, it’s an OCD! If at all she isn’t writing, you can find her shopping online or experimenting with DIY recipes. This lass currently works as a Content Writer at Coverfox.